title: Mediastinoscopy: trends and practice patterns in the United States.
abstract: OBJECTIVE
  Historically, mediastinoscopy has been the gold standard for the staging of lung cancer. A practice gap exists as the result of a variation in knowledge concerning current trends and practice patterns of mediastinoscopy usage. In addition, there are regional variations in practice-based learning and patient care. Lessons learned during surgeries performed on patients with lung cancer and other advances such as positron emission tomography and endobronchial ultrasound could be universally applied to improve surgeons' management of patient care. The purpose of this study was to assess contemporary practices in the staging of lung cancer.
  
  
  METHODS
  We queried the Society of Thoracic Surgeons National Database for data regarding mediastinoscopy usage, yield, and variation, both by year and region.
  
  
  RESULTS
  Cases with mediastinoscopy, as a percentage of all cases performed in the database, have significantly decreased from 14.6% in 2006 to 11.4% in 2010 (P < 0.001). The 5-year median rate of mediastinoscopy in lung cancer patients at 163 centers was 15.3% (interquartile range 5.2%-31.7%), indicating significant variation among centers. The overall median center rate also decreased over time from 21.4% (2006) to 10.0% (2010).
  
  
  CONCLUSIONS
  With advances in minimally invasive procedures and imaging, mediastinoscopy usage has declined significantly. Our findings are likely to be relevant to both clinical practice and practice guidelines.
authors.affiliation: From the College of Medicine, and the Department of Surgery, University of Kentucky, Lexington.
authors.forename: Krishna S
authors.initials: KS
authors.lastname: Vyas
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Davenport
authors.forename: Victor A
authors.initials: VA
authors.lastname: Ferraris
authors.forename: Sibu P
authors.initials: SP
authors.lastname: Saha
mesh_terms: D000368:Aged; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000473:pathology* / Q000601:surgery; D008297:Male; D008481:Mediastinoscopy / Q000706:statistics & numerical data* / Q000639:trends; D008875:Middle Aged; D009367:Neoplasm Staging; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data / Q000639:trends*; D014481:United States